Cardiology Coding Alert

Question: Are there E/M services I can report separately during the global period for pacemaker and ICD implant?

California Subscriber

Answer: The global period for pacemaker and ICD implants is 90 days, which covers the day before the surgery, the day of the surgery, and the 90 days after surgery. You should include surgery-related E/M services performed on those days in the implant code, meaning you should not report hospital admission, discharge, or procedure follow-up during the global period separately.

Exceptions: If the cardiologist made the decision to operate the day of the implant or the day before, you can report the appropriate E/M code for the service that resulted in the decision for surgery and append modifier 57 (Decision for surgery).

You also may report E/M codes during the global period for encounters unrelated to pacer or ICD follow-up. To indicate the service is unrelated, append modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period).

For additional guidance on Medicare’s global surgical package rules, check out www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/GloballSurgery-ICN907166.pdf.